The American Academy of Pain Medicine recently held a scientific meeting with several PREP-affiliated presenters. The topic “Non-pharmacological/Integrative Therapies: Pearls” was moderated by former PREP student, Heather Tick, MD, of the University Washington, Seattle.

The panel featured current PREP student, Marta Illueca, MD, sharing insights on spirituality and religion-based therapies across the continuum of pain and suffering; as well as PREP guest lecturer, Beth Murinson Hogans, MD discussing evidence-based recommendations for acupressure versus trigger-point massage.

The Pain Research, Education and Policy Program (PREP) is exceptionally proud that program’s director and co-founder, Dan Carr, MD is currently serving as the president of the American Academy of Pain Medicine, furthering the mission of the PREP program: “To champion an interprofessional educational program that addresses the multidimensional public health burden of pain by preparing diverse learners to contribute with expertise and compassion to pain research, education and policy.”

Five graduating PREP students took to the lectern on August 10, presenting their capstone projects to an audience of faculty, students, alumni, family and friends. After rigorous study and investigation, each student highlighted their chosen area of interest. While the capstones mark the culmination of matriculation in the PREP program, each of the graduates plan on continuing to expand their capstone projects in the areas of education, policy, and research as they move into their careers.

I recently had the pleasure of interviewing Dr. Murinson about her thoughts on the need for creation of robust interdisciplinary models of pain education.

Pamela Ressler (PR):“What are we doing well and what might be improved in educating new clinicians in treating pain?”

Dr. Beth Murinson (BM): “Educating new clinicians in treating pain starts with the fundamentals of clinical assessment but needs to be augmented with several important concepts, including the multi-dimensional impact of pain, e.g. social, functional, sleep quality, etc.; the importance of assessing and re-assessing for efficacy; developing capacity as a clinician to deliver care that is attuned to the natural history of specific pain-associated conditions, e.g. recognizing and anticipating the difference between ligamentous strain and nerve injury; as well as consistently providing care that is compassionate and patient-centered, e.g. responding to patient’s report of pain with the utmost seriousness and empathy while not being incapacitated or hardened by high levels of self-reported pain; and finally demanding of ourselves and others the development of comprehensive, multi-modal treatment plans for those devastated by treatment-resistant chronic pain.”

PR: “How can the interdisciplinary nature of pain management be brought into medical education?”

BM: “The interdisciplinary and interprofessional nature of pain management brings several opportunities for advances in step with recent developments in medical education: development of teaching teams that are interprofessional, the creation of curricular innovations that bring together students from different health professions programs, and the exposure of trainees to clinical settings where physicians of different disciplines as well as different types of health professionals are working together collaboratively. Although the current mantra is ‘assessment drives learning’, the reality is that the most enduring lessons that most of us absorb are those of the enlightening example: both positive and negative role models, as well as especially insightful teachers give us the most important and durable guidance in our careers.”PR: “How can we be change agents in pain education?”

BM: “The study of change is a field in itself and merits study by those of us wishing to foment a positive revolution. Perhaps Gandhi said it best: “We must be the change we wish to see in the world.” But change is most often the result of sustained, positive effort. Few people realize that Charles Darwin’s grandfather Erasmus actually had a well-developed theory of neuroembryologic phylogeny. In recent years he has been acknowledged as the founder of evolutionary biology popularly credited to his grandson Charles. In short, we must demand of ourselves a long-range vision, but maintain nimble readiness to innovate and insert curricula at a moments notice. Consistently reflective, eloquent advocacy with policy makers, institutional and national leadership is also essential. Know what you need to say and be ready to say it: ‘Why do you need time in the curriculum?’ ‘How will this improve care?’ and ‘Are you updated on trends in general medical education and prepared to deliver curriculum that is timely and effective?'”

As the burden of pain continues to weigh heavily on our public health and health care system, development of innovative ways of safe and effective pain management methods is imperative. The Pain Research, Education and Policy Program (PREP) is honored to have William Schmidt, PhD present the 2013 Sackler Lecture, entitled Building a Better Aspirin: The Frontiers of Pain Medicine Development on Tuesday, September 24 from 4-5 PM at the Tufts University Medical Campus, 145 Harrison Ave (Sackler Building) room 114. Dr. Schmidt is the past president of the Eastern Pain Association and an internationally-recognized expert on pain research and therapeutics. Of particular interest to Dr. Schmidt is the evolution of safer, more effective pharmaceuticals for the treatment of persistent or chronic pain. The Pain Research Forum interviewed Dr. Schmidt recently on his vision of the future of pain medicine development (click here for a link to the interview).

We hope you will be able to join us on Tuesday, September 24 for Dr. Schmidt’s lecture followed by audience discussion with Dr. Schmidt and members of the PREP program.

Among MS-PREP alumni/ae, Hallie Greenberg is redesigning templates for patient-controlled IV and epidural analgesia at the Brigham and Women’s Hospital to enhance quality and safety of pain relief. Gretchen Kindstedt is working with the Massachusetts Pain Initiative in its legislative outreach, and is on track to earn a second Master’s degree from our department – an MPH — in 2014. Ian Koebner is employed at the Pain Treatment Center at University of California at Davis, dividing his time between clinical acupuncture and interprofessional pain education. Jessica Peck is growing her acupuncture practice in Maine. Along with her MS-PREP Capstone preceptor, Jessica will teach at the 7th Annual Palliative Care Conference at Maine Medical Center in Portland in June. Heather Thomson, working in Health Outcomes and Pharmacoeconomics at Endo, recently conducted a claims analysis with collaborators in New Mexico on the prevalence of chronic pain in patients with pulmonary disease, and will report the findings in 3 abstracts and 2 papers.

Among Certificate alumni/ae, Elizabeth Carpino is now Program Coordinator for ChildKind International. Based at Boston Children’s Hospital and led by Neil Schechter (whose PREP lecture on ChildKind is viewable at our website), this program improves pediatric pain management worldwide by certifying healthcare institutions according to process and quality measures. Kathleen Norris is pursuing further studies to be credentialed as both an Adult and a Geriatric Nurse Practitioner, with the goal of positively impacting long-term care pain management practices and policies.

Among PREP faculty, Academic Director Libby Bradshaw has now overseen conversion of 4 PREP courses to a blended onsite/online format. Kudos to Libby, the Course Directors (Richard Glickman-Simon, Ewan McNicol, Pam Ressler and Steve Scrivani), their excellent TAs (Ali Carter, Kelly Murphy and Phuong Nguyen) and the students embarking on this new approach. Dan Carr recently testified on behalf of the American Society of Anesthesiologists at an FDA workshop on possible relabeling of opioid package inserts, and was elected VP for Scientific Affairs of the American Academy of Pain Medicine. Srdjan Nedeljkoviccontinues work on the BOLD (Back Pain Longitudinal Data) study evaluating outcomes of management of elderly patients with back pain. As Director of the Brigham and Women’s Pain Medicine fellowship, Serge will accept the Fellowship Excellence Award from the American Academy of Pain Medicine at its annual meeting in April. Pam Ressler attended the Narrative Medicine Workshop at Columbia University, led by Rita Charon, a national figure and pioneer in this area. Pam looks forward to using tools of narrative medicine to engage her students next summer in PREP232 (Ethical and Sociocultural Aspects of Pain).

As a nurse and through her studies within the PREP program, Amy saw an unmet need for those living with chronic pain. For her capstone, Amy envisioned a Smartphone application that would enable individuals with chronic pain to chronicle and track their “good” days. Amy explained that there are currently a number of products on the market that track pain and negative symptoms for chronic pain patients, but none that focus on good days or days with less pain. Amy plans to take her capstone project to the next level, by pursuing market research and product development.

When one thinks of chronic or persistent pain one often thinks in terms of the biologic pathways of pain perception. However, an important component of pain involves of the psychosocial aspects of coping with a chronic illness. Disciplines across the health professions, including medicine, nursing, psychology, social work, and sociology, are actively engaged in understanding the psychosocial and emotional consequences of chronic pain and illness: Yet few studies have addressed the use of web-based tools, such as blogs, in the patient experience of living with chronic pain or illness.

The goal of this research was to explore the use of patient illness blogs as a means of communicating the experience of chronic pain and illness and to articulate the unique set of benefits and barriers of blogging. Qualitative data from 230 current illness bloggers were collected and analyzed to better understand the self-perceived psychosocial and health effects associated with the blogging activity. Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a sense of purpose to help others in similar situations. While the authors’ acknowledge the study limitations, they are hopeful that further research will be conducted to explore the observed associations between communicating the experience of chronic pain through blogging and patients’ coping and self-efficacy when living with chronic pain or illness.

Your input is valuable to us as we plan our move from Boston only-based classroom learning to distance/online learning — please take this brief, 21 item educational needs survey. It should take 10 minutes or less to complete.

As has been discussed previously in this blog, the under-treatment of chronic or persistent pain places an enormous burden on individuals, the health care system, the economy and our society. In June 2011, the Institute of Medicine reported that there are an estimated 116 million individuals in the United states who report chronic pain, at an economic cost of $635 billion per year. According to a recent article by Matthew Brady in the magazine of the site, Angie’s List, (which reviews numerous categories of service and health care providers;) “health care providers in the pain management category garner negative reviews at twice the average of other Angie’s List categories” Additionally, Angie’s List members reported that their “health care provider didn’t take their problem with pain seriously”.

While reports of patient dissatisfaction with chronic pain management are disturbing, they are understandable when one recognizes the paucity of training most clinicians receive in chronic pain management. According to the Association of American Medical Colleges less than 1 in 4 of the 133 accredited medical schools in the country teach students about chronic pain management and most students receive less than 11 hours of pain management training in their entire 4 years of medical school.

Addressing the systemic lack of comprehensive pain education is a key mission of the Tufts University School of Medicine’s Pain Research, Education and Policy Program (PREP). The founding director of the PREP program, Dr. Dan Carr, states that the high level of dissatisfaction and complaints among patients seeking effective chronic pain management may reflect the traditional training of clinicians to focus only on objective measures and procedures to alleviate pain, without regard to the social and psychological aspects of persistent pain. “There is an enormous social component to pain,” states Dr. Carr. “Patients will be more satisfied if they feel they have been cared for. That has more to do with their satisfaction with pain control than the actual intensity of their pain.”

While there are no easy answers to chronic pain management; patients, clinicians, educators and health care stakeholders all agree that our current approach to pain management is inadequate and needs to be addressed as we prepare to meet the increasing health needs of an aging baby-boomer population.

What are your thoughts on how we can create a more comprehensive model of chronic pain management?

The Tufts Pain Research, Education and Policy Program congratulates Dr. Harris Berman on his recent appointment to the position of Dean of the Tufts University School of Medicine. Dr. Berman, a visionary leader in providing healthcare to populations, has a keen interest in the intersection of public health and medicine. In a recent interview in Tufts Now, Dr. Berman discussed his belief that public health should be a part of medicine, an integral part of how we care for the health of our population. Dr. Berman’s interest in population health and prevention began as a Peace Corps physician in India and continued into his leadership roles of healthcare organizations and academia.

The Tufts Pain Research Education and Policy Program began in 1999 when Dr. Berman held the position of Chair of Tufts’ Department of Public Health and Family Practice (as it was then known). A fellow visionary regarding pain as a public health concern, he welcomed PREP into that department where it has been happily housed ever since, now under the Dean of Public Health and Professional Degree Programs, Dr. Aviva Must.